Department of Anesthesiology, Gunma University, School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
J Anesth. 2011 Dec;25(6):855-9. doi: 10.1007/s00540-011-1236-y. Epub 2011 Sep 24.
This study was conducted to compare recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex with succinylcholine during electroconvulsive therapy (ECT).
Seventeen patients who were scheduled to undergo ECT were studied. Anesthesia was induced by use of propofol (1.0 mg/kg) followed by either succinylcholine (SCC) (1 mg/kg) or rocuronium (0.6 mg/kg). Assisted mask ventilation was initiated with 100% oxygen. After T1 was assessed as being zero by neuromuscular monitoring, an electroshock stimulus was applied bilaterally. Patients receiving rocuronium were infused with 16, 8, or 4 mg/kg sugammadex immediately after the seizure stopped to reverse the muscle relaxation. Neuromuscular monitoring was continued until recovery of the train-of-four ratio to 0.9 at the tibial nerve in the leg. The times to recovery of T1 to 10 and 90% with both relaxants were compared.
The time to recovery of T1 to 90% after 16 mg/kg sugammadex was shorter than that in subjects treated with SCC (p = 0.046), whereas that after 4 mg/kg sugammadex was longer than that in subjects treated with SCC (SCC group: 429 ± 65 s, 16 mg/kg sugammadex group: 387 ± 63 s*, 8 mg/kg sugammadex group: 462 ± 66 s, 4 mg/kg sugammadex group: 563 ± 45 s(*,#); *p < 0.05 compared with SCC, (#)p < 0.01 compared with 16 mg/kg sugammadex).
This study demonstrates the efficacy of rocuronium-sugammadex as an alternative to SCC for muscle relaxation during ECT, and indicates that 8 mg/kg sugammadex produces equally rapid recovery from rocuronium muscular relaxation compared with spontaneous recovery from 1 mg/kg SCC during ECT.
本研究旨在比较在电抽搐治疗（ECT）中，使用三种不同剂量的琥珀酸舒更葡糖钠逆转罗库溴铵诱导的肌肉松弛与使用琥珀酰胆碱（SCC）后恢复时间的差异。
研究了 17 名计划接受 ECT 的患者。麻醉诱导采用丙泊酚（1.0mg/kg），随后给予 SCC（1mg/kg）或罗库溴铵（0.6mg/kg）。用 100%氧气辅助面罩通气。当神经肌肉监测显示 T1 为零时，双侧施加电刺激。接受罗库溴铵的患者在抽搐停止后立即输注 16、8 或 4mg/kg 的琥珀酸舒更葡糖钠以逆转肌肉松弛。继续进行神经肌肉监测，直到胫骨神经的四成串刺激比在腿部恢复至 0.9。比较两种松弛剂恢复 T1 至 10%和 90%的时间。
与接受 SCC 治疗的患者相比，16mg/kg 琥珀酸舒更葡糖钠组恢复 T1 至 90%的时间更短（p=0.046），而 4mg/kg 琥珀酸舒更葡糖钠组恢复时间更长（SCC 组：429±65s，16mg/kg 琥珀酸舒更葡糖钠组：387±63s*，8mg/kg 琥珀酸舒更葡糖钠组：462±66s，4mg/kg 琥珀酸舒更葡糖钠组：563±45s*，#）；*p<0.05 与 SCC 相比，（#）p<0.01 与 16mg/kg 琥珀酸舒更葡糖钠相比）。
本研究表明，罗库溴铵-琥珀酸舒更葡糖钠作为 SCC 的替代方案，可用于 ECT 期间的肌肉松弛，并且表明在 ECT 期间，与 1mg/kg SCC 自发恢复相比，8mg/kg 琥珀酸舒更葡糖钠可使罗库溴铵肌肉松弛更快恢复。
